Hysterectomy Rates for Benign Indications

G Jacobson, Jacobson GF, Gavin F Jacobson, Ruth E Shaber, Ruth Shaber, Shaber RE, Armstrong MA, Mary Anne Armstrong, Hung YY, Yun-Yi Hung, Yun‐Yi Hung
Obstetrics and gynecology · 2006 · vol. 107(6) , pp. 1278–1283 · doi:10.1097/01.aog.0000210640.86628.ff · PMID:16738152 · W2062652656
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⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-07-18 ⓘ

Between 1994 and 2003, hysterectomies for benign indications declined, with laparoscopic procedures decreasing and subtotal abdominal hysterectomies increasing, leiomyoma remaining the most common reason.

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This retrospective cohort study analyzed hysterectomy trends for benign conditions among women aged 20 and older within the Kaiser Permanente Northern California health system between 1994 and 2003. The researchers identified a significant overall decline in hysterectomy rates during this period, alongside a shift in surgical approaches where laparoscopically assisted vaginal hysterectomies decreased while subtotal abdominal procedures increased. Specific indications showed varied declines, with endometriosis experiencing a 33.1% reduction in associated hysterectomy rates compared to an 11.2% drop for uterine leiomyoma, which remained the most frequent reason for surgery. Relevance to endometriosis: listed as one of the primary benign indications tracked in the study, demonstrating a significant decrease in hysterectomy rates specifically for endometriosis over the decade examined.

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Abstract

OBJECTIVE: To investigate the annual rates, types, and indications for hysterectomies performed for benign disease in Kaiser Permanente Northern California from 1994 to 2003. METHODS: All women, 20 years or age or older, who were undergoing hysterectomy for benign indications in Kaiser Permanente Northern California from 1994 to 2003 were identified. We analyzed hysterectomy rates by type, indication, and age group. Changes over time were analyzed with the Cochran-Armitage test for linear trend. RESULTS: From 1994 to 2003, there were 32,321 hysterectomies performed for benign indications. Hysterectomy rates showed a significant decline, from 4.01 per 1,000 women in 1994 to 3.41 per 1,000 women in 2003 (P for trend < .001). The relative proportions of all hysterectomies performed as laparoscopically assisted vaginal hysterectomy (LAVH) peaked at 13.0% in 1995 and then steadily declined to 3.9% in 2003 (P for trend < .001), whereas the relative proportion of subtotal abdominal hysterectomy increased from 6.9% in 1994 to 20.8% in 2003 (P for trend < .001). Hysterectomy rates declined 11.2% for uterine leiomyoma (relative risk [RR] 0.89, 95% confidence interval [CI] 0.83-0.95), 33.1% for endometriosis (RR 0.67, 95% CI 0.59-0.76), and 18.6% for uterine prolapse (RR 0.81, 95% CI 0.72-0.92). The relative proportion performed for uterine leiomyoma was consistently greater than for all other indications combined. CONCLUSION: The rates of hysterectomy for benign indications are decreasing. The type of hysterectomy changed significantly, with LAVH performed less frequently and subtotal abdominal hysterectomy increasing in popularity. Uterine leiomyoma remains the most common indication for benign hysterectomy. LEVEL OF EVIDENCE: II-2.
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Objective

To investigate the annual rates, types, and indications for hysterectomies performed for benign disease in Kaiser Permanente Northern California from 1994 to 2003.

Methods

All women, 20 years or age or older, who were undergoing hysterectomy for benign indications in Kaiser Permanente Northern California from 1994 to 2003 were identified. We analyzed hysterectomy rates by type, indication, and age group. Changes over time were analyzed with the Cochran-Armitage test for linear trend.

Results

From 1994 to 2003, there were 32,321 hysterectomies performed for benign indications. Hysterectomy rates showed a significant decline, from 4.01 per 1,000 women in 1994 to 3.41 per 1,000 women in 2003 (P for trend < .001). The relative proportions of all hysterectomies performed as laparoscopically assisted vaginal hysterectomy (LAVH) peaked at 13.0% in 1995 and then steadily declined to 3.9% in 2003 (P for trend < .001), whereas the relative proportion of subtotal abdominal hysterectomy increased from 6.9% in 1994 to 20.8% in 2003 (P for trend < .001). Hysterectomy rates declined 11.2% for uterine leiomyoma (relative risk [RR] 0.89, 95% confidence interval [CI] 0.83–0.95), 33.1% for endometriosis (RR 0.67, 95% CI 0.59–0.76), and 18.6% for uterine prolapse (RR 0.81, 95% CI 0.72–0.92). The relative proportion performed for uterine leiomyoma was consistently greater than for all other indications combined.

Conclusion

The rates of hysterectomy for benign indications are decreasing. The type of hysterectomy changed significantly, with LAVH performed less frequently and subtotal abdominal hysterectomy increasing in popularity. Uterine leiomyoma remains the most common indication for benign hysterectomy. LEVEL OF EVIDENCE: II-2

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Condition tags

endometriosis

MeSH descriptors

Hysterectomy California California Endometriosis Endometriosis Female Humans Hysterectomy Hysterectomy Hysterectomy, Vaginal Hysterectomy, Vaginal Hysterectomy, Vaginal Leiomyoma Leiomyoma Middle Aged Retrospective Studies Uterine Neoplasms Uterine Neoplasms

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